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Fever Algorithm

The document outlines a diagnostic algorithm for critically ill patients with fever, applicable after 48 hours of ICU admission. It provides a step-by-step approach to assess fever, identify clinical changes suggesting infection, and determine appropriate diagnostic evaluations based on specific sites of infection. The algorithm emphasizes the importance of targeted testing and cautions against unnecessary culture repetitions without clinical changes.

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santhosh.achar15892
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4 views2 pages

Fever Algorithm

The document outlines a diagnostic algorithm for critically ill patients with fever, applicable after 48 hours of ICU admission. It provides a step-by-step approach to assess fever, identify clinical changes suggesting infection, and determine appropriate diagnostic evaluations based on specific sites of infection. The algorithm emphasizes the importance of targeted testing and cautions against unnecessary culture repetitions without clinical changes.

Uploaded by

santhosh.achar15892
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Diagnostic Algorithm for Critically Ill Patients With Fever

Applies to Patients >48h Into Their ICU Admission

Identification of Start Device or therapy that masks fever OR Do not send


Fever Temp of >= 38.3C No immunocompromised patient PLUS No cultures, continue
or <= 36.0C clinical change concerning for infection to monitor

Yes Any of the following present? Yes


- Antibiotics are being intitiated for
a new diagnosis of infection

- Clinical signs/symptoms of
infection and presence of a CVC
Assess for
clnical - Rigors
Determination of changes
sepsis or clinical suggesting - Persistent fever and signs of
changes infection sepsis 72h after initiating
antibiotics, and blood cultures
are negative

No Yes
Peripheral blood cultures
x2 sets

Do not "pan-culture" at fixed intervals.


Evaluation and Fever Only Cultures from the same site should not be
Focused No localizing signs Diagnostic Evaluation
Diagnostics or symptoms of (see table)
repeated within 72 hours in the absence of
infection clinical change, unless looking for clearance
of bacteremia.

This algorithm is meant to serve as a guide and


does not encompass all clinical scenarios. Consider
Infectious Disease consultation and refer to ID
recommendations in complex clinical situations.
DIAGNOSTIC EVALUATION

Site of Infection Signs and Symptoms Diagnostic Testing


Bloodstream New diagnosis of serious infection - Peripheral blood cultures x2 sets if not previously obtained
Inflammation or drainage at CVC site - If concern for CVC associated infection, remove catheter
Signs of phlebitis
Rigors
Neutropenia
Mucositis
Suspicion of endovascular infection
Recent bacteremia
Intra Abdominal Peritoneal signs - Abdominal imaging with site specific culturing if infection
Ileus identified
New onset diarrhea not otherwise - Clostridium difficile DNA Assay with reflex to C. difficile
explained Toxin A and B testing if indicated
Genitourinary Dysuria/Pelvic Pain - Urinalysis with reflex urine culture
Costovertebral angle tenderness
Urinary obstruction NOTE: urinalysis should not be sent if there is high
Recent GU instrumentation suspcision for an alternative source of fever
New hematuria
Respiratory Hypoxia or change in ventilator - Sputum culture with Gram stain or Bronchial culture with
requirements Gram stain
Change in secretion quality/quantity - Viral Respiratory Panel PCR testing for influenza if
Infiltrates on chest imaging seasonally appropriate
- Chest imaging if not previously obtained
Central Nervous Altered mental status - Cerebrospinal fluid culture with Gram stain and additional
System Seizures appropriate CSF studies
Neurologic exam changes
Presence of EVD or recent
neurosurgery
Soft Tissue/Bone Purulent drainage - Wound, tissue, or body fluid culture with additional
and Joint Erythema appropriate fluid studies
Malodor
Dehiscence
Arthritis

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